Southcentral Foundation s Nuka System of Care Mercy Health Partners

Transcription

1 Southcentral Foundation s Nuka System of Care Mercy Health Partners Doug Eby, MD, MPH VP of Medical Services Melissa Shein, MD Medical Director & Customer-Owner 65,000 voices Why listen to our story Customer DRIVEN, not Patient Centered Customer-Ownership Evidenced-based generational change reducing family violence 50% reduction in ER visits, Hospital Days, and visit to Specialists 75-90% percentile on most HEDIS outcomes and quality Employee turnover rate less than 12% annually Sustained customer and staff satisfaction over 90% Baldrige National Award

2 Southcentral Foundation Fast Facts Incorporated in 1982 Serving 65,000 Customerowners 55,000 Anchorage and Valley 10, villages Employees 1987: 24 staff 2016: 2,000 staff Funding I.H.S, HRSA/CHC, VA, SAMHSA (43%) MCARE, MCAID, Private Ins (53%) We provide primary care services and 80+ programs and departments, such as: Dental, Optometry, Audiology Behavioral health, Addictions, Residential Primary Care, OB, Peds, ED Fast Track PT, OT, Complementary medicine Traditional Healing, Wellness Warriors RAISE program, Elders, Home Health Villages health aide, BHA, DHAT, Telem. Devel Ctr, Nuka Inst., ASTP, Eval, Resrch 13 Years Service 13 Years Service 7 Years Service 16 Years Service 34 Years Service 12 Years Service 7 Years Service Southcentral Foundation Board of Directors 2

3 591,000 square miles Alaska is larger than Texas, California and Montana combined Indian Self-Determination and Education Assistance Act 1975 Summary of Congressional Findings: Prolonged federal domination of Indian Health Service programs has served to retard rather than enhance progress of Indian people and their communities denied an effective voice in the planning and implementation of programs that respond to the true needs of the people 3

4 Government recognized If the people receiving the health service are involved in the decision making processes, better yet, if they own their own health care programs and services have a potential for enhancement and the people and their health statistics will improve. Ask the Community Governing board Advisory committees Elders Council Annual Gatherings 24- hour hotline Personal interactions Customer-owners Satisfaction surveys and comment cards Employee survey and satisfaction surveys Employee interactions (over 55% are customer-owners) 4

5 Listen to the Community Governing board Advisory committees Elders Council Annual Gatherings 24- hour hotline Village Service Management Team Alaska Federation of Natives Alaska Native Health Board Advisory Committees 5

6 Village Service Management Team Engaging the Community Satisfaction surveys and comment cards Employee survey and satisfaction surveys Employee interactions (over 55% customer-owners) Personal interactions Survey Monkey 6

7 The Gathering Customer-Owners in the Workforce More than 50% of Southcentral Foundation s employees are Alaska Native / American Indian people 65% of managers are Alaska Native / American Indian people Workforce development programs and scholarships help Southcentral Foundation grow our own 7

8 Providers and Customer Owners in Shared Responsibility Key Improvement Customer-owner changes We are active We are responsible We seek information We ask questions We seek advice and options We become a partner with the Provider 8

9 Key Improvement Customer-owner changes Actively involved in partnership with your Primary Care Provider Take responsibility for your health Get information about your health Ask questions about advice Ask for options Key Improvement Health care provider changes No longer a hero, but a partner Control Compliance Replace blaming with understanding Give customers options, not orders Providers customers with resources Make it simple 9

10 Key Improvement Health care provider changes No longer gives orders No longer just prescribes meds No longer our hero No longer controls Gives customers options Provides customer with resources Provider becomes our partner Strengths and Assets Family identity, loyalty, caring sense of identity/belonging Shared housing, food, finance - sharing Tribal/Village identity, loyalty, caring sense of place Annual Cycle of Life fishing, hunting, gathering, traditions Languages Yupik, Inupiaq in particular. Some others Mobility w/o loss of services/identity/belonging Emphasis on school, academics, scholarships, mentors 10

11 Strengths and Assets Respect for Elders, Story Telling Spirituality, Religion Available Traditional Foods and Food Prep Annual Cycle of the Year Traditions Support for Youth Traditional Healing, Healers, Plants, Medicinal Preps. Corporations, Non-Profits/webs of services Web of Services Alaska Native Medical Center SCF community, primary care, resid., addictns/recovery, clinical Housing CIHA Education, Jobs, Family CITC Justice Center ANJC CIRI/other Scholarships SCF Devel Center ANHC, KNBA Covenant, BFS, Beans ANSEP, RRANN RAISE, other youth programs AN Churches Charter School Covered Travel Southcentral Foundation. All rights reserved. 11

12 Complexity Migration from Rural to Urban Subsistence to cash based Unstable housing, unemployment, education challenges Tobacco, Alcohol, Obesity Generational Trauma Violence Jail Resilience Pain, Abuse, addictions, Suicide Diabetes, Cancer, BH, COPD, CHF 3-5X complexity Alaska Native people chose to assume responsibility 12

13 Who really makes the decisions? 100% Control 0 Low Acuity High 1. Control who makes the final decision influencing outcome? 2. Influences family, friends, co-workers, religion, values, money 3. Real opportunity to influence health costs/outcomes influence on the choices made behavioral change 4. Current model tests, diagnosis, treatment (meds or procedures) Hitting The Target: Rock vs. Bird 13

14 Certainty or Agreement 12/4/2016 Some simple rules for improvement Low High Experimenting Chaos Get together and have An dialogues allowing/positive Complexity environment Multidimensional improvements with Protocols target focus Creativity & Stds Low complexity - variables High complexity diagram Customer Ownership 14

15 Vision A Native Community that enjoys physical, mental, emotional and spiritual wellness Mission Working together with the Native Community to achieve wellness through health and related services Goals S hared Responsibility C ommitment to Quality F amily Wellness 15

16 Operational Principles Centers of Excellence Disease specific days/experts Diabetes, Heart Disease, Cancer Specific Primary Care Pediatrics, Gynecology, Geriatrics, Adolescent, etc. Whole Person/Family Primary Care Family/Household/Context emphasis Three Options Lifelong, whole person Bring disease and discipline specific care into primary care Community/Home Based 16

17 Story Behind Our Eyes The Integrated Care Team Primary care provider - MD, DO, NP/PA Nurse Case Manager Case Management Support Certified Medical Assistants Behaviorists Dieticians Pharmacist Nurse Midwife Coverage NP/PA/CMs Co-located Psychiatry 17

18 Key Improvement Basic Fundamentals Same day access to Primary Care Provider and Entire Team Primary Care Teams and Integrated Care Teams highly skilled in team Culturally appropriate care, Mind-Body reconnected Max-Packing, Data Mall, Virtual Care, Redefined specialist relationships Improvement Advisors, Annual plans, Mentors, Coaches, Team Development Extended Services HIV Advisor Nutaqsiivik / FNP Home Health Waiver Care coordin. Dena A Coy Medical Social Worker Elders Program RAISE program ECHO style telemed Neurodevel. 18

19 BH Everywhere BHC Primary Care BHC in MH clinics Counseling Talking Circles Family Wellness Warriors Traditional Healing Elders Program, Nutaq Psych Co-Location Suboxone Addictions BURT Inpt Consult Liason Q-Clubhouse CMI Child-Adolesc Psych Crisis Team Wellness Care Plans Residential youth, pregnant, adults, etc. 4 Directions Wellness Care Plan Why do we need this approach to care? System centered around Shared Responsibility Can t just use the language, need to operationalize Complexity of our customer-owner population Emotional, physical, geographical challenges, etc. Resource rich environment but still high levels of burnout Use resources well and share the responsibility Accountability is key you don t have to be the hero 19

20 Partnering with Customer Owners Living with Chronic Pain Data Mall Action Lists Controlled Medication Agreement Controlled Medications - 12 month Opiate snapshot Integrated Pain Consultant PM&R State of Alaska Drug Monitoring Website Controlled Medication Agreement & Opioid Guidelines Wellness Care Plans EHR & SharePoint Integrated Care Team members Opiate Review Committee Multidisciplinary Pain Team Support Clinics Comp Med, PT, exercise, Traditional Healing, Health Ed. Behavioral Health all integrated 20

21 Family Wellness Warriors Initiative Goal To End Domestic Violence, Child Sexual Abuse, and Child Neglect in the State of Alaska in this Generation. 21

22 About FWWI Utilizes best practices All walks of life attend trainings (Examples: CEOs, Maintenance Staff, Pastors, Administrators, Law Enforcement, Political Figures, etc.) The Power of Story in Generational Healing Attachment research shows that adults who remember and tell their story in a full and honest way are unlikely to repeat generational abuse. (Main, M. & Goldwyn, R. (1984). Child Abuse and Neglect v8:20317) 22

23 Statistically significant positive change at 12 months on standardized measures of Spiritual Wellbeing 8.7% Average improvement after training Protective Factors Self-esteem 7.5% Average improvement after training Family Cohesion 4.9% Average improvement after training Cultural Connectedness 4.3% Average improvement after training And if you re better, if you re healthier, then you have a healthier relationship with your family and your children. -FWWI participant I m very thankful for Family Wellness Warriors, because it has helped me to communicate better with my family members. -FWWI participant My dad, where he went to school, was punished for speaking his language and punished for doing any kind of cultural subsistence activities and he really made sure to a point that I would know nothing about what was traditional. FWWI healed that part of me, I started remembering things: the way my grandmother danced, the food and things they loved -FWWI participant Statistically significant negative change at 12 months on standardized measures of Trauma symptomology 51% Average reduction after training Quality of Life Depression 48% Average reduction after training Substance abuse 49% Average reduction after training Anxiety 25% Average reduction after training There was so much situations reminding me of witnessing helpless moments when I was a kid [since FWWI] I don t get entangled anymore -FWWI Participant With any kind of event in my life and the way I used to react was just to use or drink. But being sober this program showed me and gave me the tools to process in a healthy way -FWWI Participant 23

24 Key Improvement Building redesign Culturally appropriate Meet clinical and administrative needs Clean and beautiful Key Improvement Workforce Development More than 50% of Southcentral Foundation s employees are Alaska Native / American Indian people 65% of managers are Alaska Native / American Indian people Workforce development programs and scholarships help Southcentral Foundation grow our own 24

25 93 96 % Employee Satisfaction 2015 Sustained Improvements 23 % Reduction ER Visits 2008 to 2015 % Customer Overall Satisfaction % Reduction Primary Care Visits 2008 to 2015 Exceeds 90 th percentile compared nationally in HEDIS (measured ongoing) Board certification Diabetes LDL <100 Diabetes care annual testing Asthma appropriate medications Tobacco screening and quit rates Cardiovascular disease control <100 Sustained Improvements 75 th - 90 th percentile compared nationally in HEDIS (measured ongoing) Cervical and breast cancer screening rates Cardiovascular disease LDL screenings 25

26 Feedback from the People What We Covered SCF discovering customer-ownership and relationships based care - creating the Nuka System of Care Engagement with communities of customer-owners, and specifically how SCF s builds the Nuka System of Care around their feedback The basics of SCF s primary care system, including behavioral health integration, building design and population health How this all applies to complex individuals 26

27 Would you want to work for a company like SCF? Would you like to live in Alaska? 27

28 Are you sure? 28

29 Questions? Southcentral Foundation. All rights reserved. 29

30 Thank You! Qaĝaasakung Aleut Quyanaa Alutiiq Quyanaq Inupiaq Awa'ahdah Eyak Mahsi' Gwich in Athabascan Quyana Yup ik Igamsiqanaghhalek Siberian Yupik Tsin'aen Ahtna Athabascan T oyaxsm Tsimshian Háw'aa Haida Gunalchéesh Tlingit Chin an Dena ina Athabascan 30